Relatives dancing with the corpses of their loved ones are helping to spread the plague, officials have warned

And officials are warning that the annual All Saints Day, taking place today could trigger a spike in cases as people gather to honour the dead.

Professor Jimmy Whitworth, an international public health scientist at the London School of Hygiene & Tropical Medicine, says the outbreak could continue to worsen as the disease has exploded in capital Antananarivo and is now spreading to coastal cities.

Speaking with the Mail Online, he said: “Madagascar is the most plague-endemic country in the world and has outbreaks every year at about this time, this outbreak though is the worst for 50 years or more. “

The airborne pneumonic plague, which has been responsible for the most of the deaths this year, is spread through coughing and sneezing.